Changewave Research: Infections and Wound Treatments

ChangeWave Research: Infections and Wound Treatments

ChangeWave Research Report:

Infections and Wound Treatments

A Look at Hospital Acquired Infections and Antiseptics

Overview

A recent ChangeWave healthcare survey focused on the treatment of infections and wounds – including Hospital Acquired Infections (HAIs) and Methicillin-Resistant Staphylococcus Aureus (MRSA). The survey was conducted October 11 -16, and 204 healthcare respondents working in a hospital or clinic participated – including 135 doctors.

(A) Hospital Acquired Infections (HAIs)

Bottom Line: Given recent news coverage on the dangers of Hospital Acquired Infections (HAIs), it's not surprising that three-quarters of respondents (74%) say their hospital or clinic has a formal plan to reduce HAIs. However, it’s noteworthy that Isolating Infected Patients (69%) is currently the top reported measure for reducing HAIs at respondent hospital/clinics.

The vast majority of respondents (86%) say their hospital tests for Methicillin-Resistant Staphylococcus Aureus (MRSA) – a common HAI. Among this group, 62% say they test for MRSA if the patient has an open wound, while 49% test only when symptoms are present.

We also asked respondents about GeneXpert – an MRSA test from Cepheid (CPHD) – and 7% said their hospital currently uses the system. However, another 16% say they plan to begin using GeneXpert over the next 12 months.

(B) Methicillin-Resistant Staphylococcus Aureus (MRSA)

Bottom Line: In terms of MRSA treatments, 65% of doctors say Vancomycin is the primary drug used at their hospital/clinic. Why Vancomycin? As Doctor JET82619 puts it, “Vancomycin is the gold standard and it is relatively inexpensive." Doctor NPC99778 adds, "Vancomycin is proven for the treatment of established, invasive MRSA infections.” Additional commentary can be found in Appendix A.

Another primary MRSA treatment cited by respondents is a combination of the antibiotics Trimethoprim and Sulfamethoxazole (18%).

We also note that Ceftobiprole – a cephalosporin antibiotic that’s a potential Vancomycin competitor – is currently in advanced Phase III clinical development for MRSA treatment. Johnson & Johnson (JJ) is co-developing Ceftobiprole along with Swiss company Basilea Pharmaceutica. If approved, the consensus among doctor respondents is that 41% of patients with MRSA would be candidates for receiving Ceftobiprole.

(C) Antiseptics and Wound Treatments

Bottom Line: We also asked doctors which antiseptics they use to clean wounds, and four solutions emerged as the industry frontrunners: Chlorhexidine Gluconate (54%), Sodium Chloride (53%), Iodine (48%) and Hydrogen Peroxide (47%).

In terms of the biggest reasons for recurring wounds, nearly two-thirds of doctors (63%) believe that medical issues specific to the individual contribute most. Another 25% cite a lack of patient compliance to medical advice.

Summary of Key Findings

The ChangeWave Alliance is a group of 13,000 highly qualified business, technology & medical professionals in leading companies

of select industries—credentialed professionals who spend their everyday lives working on the frontline of technological change. ChangeWave surveys its Alliance members on a range of business and investment research and intelligence topics, collects feedback from them electronically, and converts the information into proprietary quantitative and qualitative reports.

Helping You Profit From A Rapidly Changing World ™

www.ChangeWave.com

Table of Contents

Summary of Key Findings 2

The Findings 4

(A) Hospital Acquired Infections (HAIs) 4

(B) Methicillin-Resistant Staphylococcus Aureus (MRSA) 6

ChangeWave Research Methodology 12

About ChangeWave Research 13

Appendix A 14

I. The Findings

Introduction

(A) Hospital Acquired Infections (HAIs)

Healthcare Respondents Who Work in a Hospital or Clinic (n=204)

(1) Which of the following statements best describes your hospital/clinics plans to reduce the occurrence of Hospital Acquired Infections (HAIs)?

Work in
Hospital/
Clinic
We Have a Formal Plan in Place to Reduce the Occurrence of HAIs / 74%
We Have an Informal/Tentative Plan to Reduce the Occurrence of HAIs / 17%
We Currently Have No Plans to Reduce the Occurrence of HAIs / 5%
Don't Know/No Answer / 2%
Other / 1%

(1A) Which of the following measures are already included (or will be included) in your hospital/clinics plans to reduce the occurrence of Hospital Acquired Infections (HAIs)? (Check All That Apply)

Work in
Hospital/
Clinic
Isolating Infected Patients / 69%
Implementing Standard Treatment Protocols for Specific Infections / 67%
Testing for HAIs if Patient has an Open Wound / 46%
Testing for HAIs if Patient is Admitted to ICU / 30%
Testing for HAIs Only When Symptoms Occur / 29%
Testing for HAIs Before Admittance / 23%
Testing All Patients Over 65 as They are Admitted / 6%
Other / 7%

Plans to Reduce HAIs. Currently, three-quarters of respondents (74%) say their hospital or clinic has a formal plan to reduce HAIs. Another 17% have an informal plan. Only 5% report they have no plan at all.

Respondents report Isolating Infected Patients (69%) is the top reported measure for reducing HAIs at respondent hospital/clinics, followed by Implementing Standard Treatment Protocols for Specific Infections (67%).

(2) Does your hospital/clinic currently test for the Methicillin-resistant Staphylococcus aureus (MRSA) infection in any capacity?

Work in
Hospital/
Clinic
Yes / 86%
No / 12%
No Answer / 2%

(2A) If so, which of the following best describes your hospital/clinics current protocol for MRSA testing? (Check All That Apply)

Work in
Hospital/
Clinic
(n=175)
Testing for MRSA if Patient has an Open Wound / 62%
Testing for MRSA Only When Symptoms Occur / 49%
Testing for MRSA if Patient is Admitted to ICU / 37%
Testing for MRSA Before Admittance / 21%
Testing All Patients Over 65 as They are Admitted / 6%
Other / 9%

When to Test for HAIs. The vast majority of respondents (86%) say their hospital tests for Methicillin-Resistant Staphylococcus Aureus (MRSA) – a common HAI. Among this group, 62% say they test for MRSA if the patient has an open wound, while 49% test only when symptoms are present.

(3A) Molecular diagnostics company Cepheid provides a platform known as the GeneXpert system – which offers 'on-demand' MRSA testing with results in real-time. Does your hospital/clinic currently use the GeneXpert system to test for MRSA?

Work in
Hospital/
Clinic
Yes / 7%
No / 81%
No Answer / 13%

(3B) Over the next 12 months, does your hospital/clinic plan to begin using the GeneXpert system to test for MRSA?

Work in
Hospital/
Clinic
Yes / 16%
No / 64%
No Answer / 21%

Cepheid's (CPHD) GeneXpert System. We also asked respondents about GeneXpert – an MRSA test from Cepheid (CPHD) – and 7% said their hospital currently uses the system. However, another 16% say they plan to begin using GeneXpert over the next 12 months.

(B) Methicillin-resistant Staphylococcus Aureus (MRSA)

Doctors Who Work in a Hospital or Clinic (n=135)

(4) Which of the following drugs – if any – does your hospital/clinic or practice currently recommend for treating MRSA? (Check All That Apply)

Doctors in a Hospital/ Clinic
Vancomycin / 81%
Trimethoprim and Sulfamethoxazole (Co-trimoxazole) / 45%
Clindamycin / 42%
Linezolid / 26%
Antistaphylococcal Penicillins / 23%
Doxycycline or minocycline / 21%
Rifampicin and Fluoroquinolone / 18%
Daptomycin / 11%
Tigecycline / 7%
Rifampicin and Fusidic Acid / 6%
Teicoplanin / 4%
Pristinamycin / 1%
Quinupristin/Dalfopristin / 1%
Not Applicable / 3%
Other / 5%

(5A) And which one of the following drugs is the primary treatment your hospital/clinic or practice currently recommends for treating MRSA? (Please Choose Only One)

Doctors in a Hospital/ Clinic
Vancomycin / 65%
Trimethoprim and Sulfamethoxazole (Co-trimoxazole) / 18%
Clindamycin / 2%
Antistaphylococcal Penicillins / 1%
Doxycycline or minocycline / 1%
Linezolid / 1%
Rifampicin and Fluoroquinolone / 0%
Daptomycin / 1%
Tigecycline / 0%
Pristinamycin / 0%
Quinupristin/Dalfopristin / 0%
Rifampicin and Fusidic Acid / 0%
Teicoplanin / 0%
Not Applicable / No Answer / 7%
Other / 3%

(5B) Why do you recommend that particular drug for treating MRSA? Please elaborate.

A Sample of Alliance Member Responses Can Be Found in Appendix A.

Treating MRSA. In terms of MRSA treatments, 65% of doctors say Vancomycin is the primary drug used at their hospital/clinic. Why Vancomycin? As Doctor JET82619 puts it, “Vancomycin is the gold standard and it is relatively inexpensive." Doctor NPC99778 adds, "Vancomycin is proven for the treatment of established, invasive MRSA infections.”

Another primary MRSA treatment cited by respondents is a combination of the antibiotics Trimethoprim and Sulfamethoxazole (18%).

(6) Inhaled versions of Vancomycin are seen as a treatment of last resort in certain patients. If a broader-spectrum version for inhaled Vancomycin were approved by the FDA (one is currently in mid-stage trials), what percentage of patients with MRSA do you see as logical candidates for this kind of treatment?

Doctors
in a
Hospital/ Clinic
0% / 2%
1-10% / 19%
11-20% / 12%
21-30% / 8%
31-40% / 10%
41-50% / 3%
51-60% / 6%
61-70% / 1%
71-80% / 1%
81-90% / 1%
91-100% / 1%
NA/Not Applicable / 4%
Don't Know / 32%

Consensus Estimate = 25.6%

Inhaled Vancomycin. The consensus among doctor respondents is that 25.6% of patients with MRSA would be candidates for a broader-spectrum version of Inhaled Vancomycin – if approved by the FDA.

(7) A new drug for treating penicillin-resistant patients, Ceftobiprole, is an anti-MRSA broad-spectrum cephalosporin antibiotic. The drug is in advanced Phase III clinical development. If and when approved, what percentage of patients with MRSA do you see as logical candidates for this kind of treatment?

Doctors
in a
Hospital/ Clinic
0% / 1%
1-10% / 7%
11-20% / 7%
21-30% / 12%
31-40% / 13%
41-50% / 10%
51-60% / 11%
61-70% / 3%
71-80% / 5%
81-90% / 4%
91-100% / 2%
NA/Not Applicable / 4%
Don't Know / 21%

Consensus Estimate = 41.2%

New Antibiotic for MRSA. Ceftobiprole – a cephalosporin antibiotic that’s a potential Vancomycin competitor – is currently in advanced Phase III clinical development for MRSA treatment. Johnson & Johnson (JJ) is co-developing Ceftobiprole along with Swiss company Basilea Pharmaceutica. If approved, the consensus among doctor respondents is that 41% of patients with MRSA would be candidates for receiving Ceftobiprole.

(8) Does your practice/work locale currently treat any type(s) of wounds?

Doctors in a Hospital/ Clinic
Yes / 75%
No / 21%
No Answer / 4%

(8A) What type(s) of wounds do you/your practice treat? (Check All That Apply) (n=101)

Doctors in a Hospital/ Clinic
Lacerations / 80%
Surgery Wound Breakdown / 78%
Diabetic Skin Sores / 73%
Pressure Sores / 69%
Burns / 63%
Vessel Disease Wounds / 62%
Chemical Wounds / 50%
Not Applicable / 3%
Other / 3%

(8B) Overall, how satisfied are you/your practice with the efficacy of the antiseptics used to treat wounds? (n=101)

Doctors in a Hospital/ Clinic
Very Satisfied / 26%
Somewhat Satisfied / 48%
Somewhat Unsatisfied / 19%
Very Unsatisfied / 2%
Don't Know / 6%

(8C) Which of the following antiseptics do you/your practice regularly use to clean wounds? (Check All That Apply) (n=101)

Doctors in a Hospital/ Clinic
Chlorhexidine Gluconate / 54%
Sodium Chloride / 53%
Iodine / 48%
Hydrogen Peroxide / 47%
Alcohol / 27%
Quaternary Ammonium Compounds (Quats) / 9%
Boric Acid / 1%
Phenol (carbolic acid) Compounds / 1%
Not Applicable / 4%
Other / 10%

Top Antiseptics. We also asked doctors which antiseptics they use to clean wounds, and four solutions emerged as the industry frontrunners: Chlorhexidine Gluconate (54%), Sodium Chloride (53%), Iodine (48%) and Hydrogen Peroxide (47%).

(8D) Which of the following do you believe contributes most to the recurrence of wounds (or their lack of healing)? (n=101)

Doctors in a Hospital/ Clinic
Medical Issues Specific to Patients / 63%
Patient Compliance Problems / 25%
Limited Efficacy of Antibiotics / 3%
Insurance Issues/Costs / 3%
Limited Efficacy of Antiseptics / 1%
Not Applicable/No Answer / 1%
Other / 4%

Contributors to Wound Recurrence. In terms of the biggest reasons for recurring wounds, nearly two-thirds of doctors (63%) believe that medical issues specific to the individual contribute most. Another 25% cite a lack of patient compliance to medical advice.

(8E) Based on your experience, what is the single best antiseptic for killing the widest range of micro-organisms and promoting wound healing? (Open-Ended) (n=126)

Chlorhexidine Gluconate / 24%
Betadine / 18%
Iodine / 13%
Hydrogen Peroxide / 10%
Soap and Water / 6%
Saline / 5%
Alcohol / 3%
Debridement / 2%
Quartenary Amonium (QUATS) / 2%
Good Hygiene / 2%
Silvadene / 2%
Phisohex / 2%
Other / 13%

(8F) Are you aware of any new antiseptics in development that may eventually replace currently used antiseptics? If so, please describe.

Sample of Alliance Member Responses:

· Doctor PRI93176 writes, "There is a new agent that I think is a biguanide that is being used in some Kendall dressings. Overall, most of my experience in dressings is to use ionic silver, the best of which is Acticoat."

· Doctor LVM96100 writes, "Nanoparticle silver."

· Doctor SPA88771 writes, "Ionic Silver Rx looks promising especially when combined with Wound Vac Rx."

· Doctor STE3218 writes, "More effort on protecting wounds (silver dressings) from initial infection."

· Doctor PEG8651 writes, "There is Altabax ointment that is used for resistant bacteria."

· Doctor DCH99373 writes, "Oculus’ new activated chlorine drug.”

· Doctor KIT96549 writes, "Vacuum wound closure."

· Doctor PBA99583 writes, "Omiganan hydrochloride"

· Doctor JOB65288 writes, "One not mentioned but particularly effective is Hygel. This is a sodium hypochlorite solution diluted to 1:20. It can be used for irrigation and soaks, particularly for post operative wound infections. Iodoform gauze packing is also very good."

II. ChangeWave Research Methodology

This report presents the findings of a recent ChangeWave Alliance healthcare survey on Infections and Wounds. The survey was conducted between October 11 - 16, 2007. A total of 204 healthcare respondents who work in a hospital or clinic participated, including 135 doctors.